[Rhegmatogenous retinal detachment: Topography of breaks and agreement with lincoff's rules]

PURPOSE

To study the topography of retinal breaks and their agreement with Lincoff's rules.

MATERIALS AND METHODS

We performed a retrospective descriptive study of patients with recent rhegmatogenous retinal detachments followed on the ophthalmology service of Abass Ndao Hospital from January 2006 through December 2016. Patients with no prior retinal treatment were included.

RESULTS

Over 11 years, we reviewed 97 patients with 107 eyes with retinal detachments. The mean age of our patients was 51.7 years, range 23-79 years. There were 69 male patients, for a male:female ratio of 2.46. Refraction revealed that 38.1% of patients were myopes. Fourteen percent (14%) of patients had experienced trauma to the eye with the detachment. The right eye was involved in 54.6% of patients. The onset was insidious in 54.6% of cases and sudden in 23.7% of cases. All patients had decreased visual acuity, associated with a scotoma in 26.8% of cases. Visual acuity was decreased to light perception through 7/10. In 64.9% of cases, Lincoff's rules were observed.

DISCUSSION

Lincoff's rules are still relevant for localization of the breaks in retinal detachments.

CONCLUSION

Diagnosis of a retinal detachment is an essential step, since it determines the treatment. Lincoff's rules still have a role in finding the retinal break in retinal detachments.

[Role of CT in diagnosis and monitoring of retinoblastoma in Senegal]

INTRODUCTION

Retinoblastoma is a malignant tumor of neuroepithelial origin, developed from young retinal cells, occurring in infants and young children. The goal of the study was to assess the role of CT in the diagnosis of retinoblastoma at the Aristide le Dantec Hospital in Dakar.

PATIENTS AND METHODS

This is an 11-year retrospective study of 160 patient records in the ophthalmology department and pediatric oncology unit of the same hospital.

RESULTS

One hundred and sixty (160) patients were recruited. The male:female ratio was 1.05. The mean age was 32.19 months. Leukocoria was the most common clinical sign, occurring in 105 cases (65.62 %). The retinoblastoma was intraocular in 97 cases (60.62 %). We saw 122 (76.25 %) unilateral and 3 (1.87 %) trilateral presentations. CT was performed in 150 children with 110 cases (73.33 %) of calcifications ; 62 cases (41.33 %) of optic nerve invasion ; 24 cases (16 %) of extraocular muscle invasion and 18 cases (12 %) endocranial extension. Associated tumors were found on CT: 2 cases of suprasellar mass and 1 case of pineoblastoma. In patients whose specimens were analyzed, histology showed 48.15 % optic nerve invasion, consistent with the CT findings.

DISCUSSION

CT has an important role in the diagnosis of retinoblastoma, despite its recent contraindication in bilateral and unilateral multinodular forms.

CONCLUSION

CT is a good alternative to MRI in the diagnosis of retinoblastoma in developing countries with limited technological resources.

[Ametropia among senegalese children in a hospital setting]

INTRODUCTION

Ametropia is common in children and cause strabismus and amblyopia. The goal was to establish its prevalence in a hospital setting among Senegalese children.

PATIENTS AND METHODS

This was a retrospective study of patients under 15 years of age with clear ocular media. The marital status, circumstances of discovery, and results of cycloplegic refraction were recorded.

RESULTS

Of 1506 children, 175 demonstrated ametropia. The mean age was 8 years, and the male : female ratio was 0.68. Family history of ametropia was present in 8.5 %. Decreased VA was present in 39.66 %, headache 10.06 %, and strabismus 4.47 %. Automated refraction in 109 patients and skiascopy in one patient showed 58.18 % cases of myopia, 18.18 % of hyperopia and 36.57 % of astigmatism.

DISCUSSION

The most common ametropia was myopia. Patients were referred for symptomatic ametropia.

CONCLUSION

Screening for ametropia might occur earlier if it is associated with pediatric monitoring in our regions.

[Giant retinal tears: Senegalese experience]

PURPOSE

To appreciate the epidemiological characteristics and to show the therapeutic aspects of the giant retinal tears.

PATIENTS AND METHODS

We conducted a retrospective study from January 2014 to June 2017 on subjects with giant retinal tears. Patients with media opacities limiting examination were excluded.

RESULTS

We identified 17 cases of giant retinal tears. The frequency of detachments related to a giant retinal tear was 17% compared to all retinal tears. The mean age was 50.75 years with a sex ratio (M/F) of 6.5. We found three cases of high myopia, one case of hyperopia and four trauma cases. All patients had a decrease in visual acuity. The average time to consultation was four weeks. The mean intraocular pressure was 8mmHg. The tear was found in the left eye in eight cases and in the right eye in five cases; two cases were bilateral. We performed intraocular surgery in five eyes and laser in four eyes. We achieved anatomical reattachment and functional improvement in all operated patients.

COMMENTS AND CONCLUSION

The prognosis of a giant retinal tear remains guarded, especially if patients are seen and treated late. Laser photocoagulation of giant tears remains effective, especially in cases of early diagnosis.

[Evaluation of mean macular thickness by optical coherence tomography (SD OCT) in black Senegalese subjects]

INTRODUCTION

Our goal was to evaluate the normal macular thickness in Blacks by OCT and to determine socio-demographic and clinical parameters which may influence it.

MATERIALS AND METHODS

This was a multicenter, prospective, descriptive study over 6 months. It included Black adults followed in the ophthalmology departments of Abass Ndao and Aristide-Le-Dantec hospitals in Dakar. Included subjects had corrected visual acuity of 10/10 (0 logMAR) and P2 (+0.1 logMAR), clear ocular media, and no retinal abnormalities. We used the Topcon 3D 2000 OCT to measure the central thicknesses of the cornea (CT) and of the macula (MT), and cup to disc ratio (C/D) in each eye. Socio-demographic, clinical and tomographic data were collected on a survey form and correlated to the MT. The analysis was carried out by the Epi info 7 software. We used the Chi² comparison test with a P value˂0.05.

RESULTS

One hundred and nine patients were included. The mean age was 27.39 years with a male/female ratio of 0.65. The subjects were emmetropic in 54.13% of cases. The mean CT was 519.97μm, the mean C/D was 0.23, and the mean MT was 264.35μm. The P-value (P) was greater than or equal to 0.1 for all the factors studied.

CONCLUSION

MT in our study was lower than that of Whites, and the various parameters studied did not demonstrate a statistically significant influence on MT.

[Perception of ocular blinding manifestations of sickle cell disease by practitioners in Dakar university hospital]

INTRODUCTION

In Senegal, 10% of the population are said to be carriers of hemoglobin S, the most widespread hemoglobinopathy in the world. It is responsible for potentially blinding ophthalmological manifestations. Few practitioners refer patients for ophthalmologic screening. The goal of our study was to assess the level of knowledge of practitioners of the blinding ocular lesions of sickle cell disease.

MATERIALS AND METHODS

A cross-sectional prospective study was carried out over five months. It included Dakar university hospital practitioners aside from ophthalmologists. On the survey form, each practitioner specified his or her specialty and responded to eight questions regarding sickle cell patients seen in consultation, knowledge of the blinding lesions related to the disease, and ocular monitoring for blinding systemic diseases. The practitioners were divided into three groups: department of medicine and medical specialties (group I), surgery and surgical specialties (group II), and biology and functional testing (group III). The descriptive analysis was done with the EPI-INFO software version 6.04.

RESULTS

The participation rate was 45.88%. Group I represented 45.29% of the sample, Group II 35.85% and Group III 18.86%. In all, 87.73% of practitioners saw sickle cell patients in consultation, 75.47% were aware of ocular involvement related to sickle cell disease, and 58.49% were aware of blinding lesions. 94.62% of practitioners saw sickle cell disease patients without systematically recommending ophthalmological consultation.

CONCLUSION

Practitioners' level of knowledge of the blinding ocular lesions of sickle cell disease is considered to be low.

[Rare causes of childhood leukocoria]

PURPOSE

The purpose was to record the causes of leukocoria among children under 10years of age and to determine the proportion of rare causes of leukocoria.

PATIENTS AND METHODS

This retrospective study was conducted over a period of ten years, from January 1, 2004 to December 31, 2013, in patients under 10years of age who were referred for leukocoria.

RESULTS

Leukocoria represented one of the ten reasons for consultation among children under 10years of age. The mean age of our patients was 42.5months. In 76 % of cases, the leukocoria patients were children under 6years of age. Male patients were affected more commonly, with a sex-ratio of 1.5. Patients coming from Dakar and its suburbs represented two thirds of the total. Bilateral involvement represented 53.7 % of the total. Cataracts were responsible for 74.3 % of cases, retinoblastoma 20.58 %, retinal detachment 0.96 %, retinopathy of prematurity 0.96 %, pupillary membrane persistence 0.96 %, persistent hyperplastic primary vitreous 0.64 %, endophthalmitis 0.64 %, optic nerve coloboma 0.32 %, iris heterochromia 0.32 % and ametropia 0.32 %.

DISCUSSION

The total percentage of rare causes was 5.12 % in our study, including one case of hyperopia. These etiologies, although rare, do exist.

CONCLUSION

Rare causes of leukocoria require special attention. The discovery of leukocoria necessitates rigorous etiological work-up. Ametropia must be a diagnosis of exclusion.

First outbreak of colonization by linezolid- and glycopeptide-resistant Enterococcus faecium harbouring the cfr gene in a UK nephrology unit

AIM

To describe an outbreak of colonization by linezolid- and glycopeptide-resistant Enterococcus faecium harbouring the cfr gene in a UK nephrology unit.

METHODS

Isolates of linezolid-resistant E. faecium were typed by pulsed-field gel electrophoresis (PFGE), and examined by polymerase chain reaction (PCR) and sequencing for the transmissible cfr gene that confers resistance to linezolid. Enhanced environmental cleaning, initial and weekly screening of all patients, and monitoring of adherence to standard infection control precautions were implemented.

FINDINGS

Five patients with pre-existing renal disease were found to have rectal colonization with linezolid-resistant E. faecium over a two-week period. The index case was a 57-year-old male from India who had travelled to the UK. One patient also had a linezolid-resistant E. faecium of a different PFGE profile isolated from a heel wound. All isolates were confirmed to harbour the cfr gene by PCR and Sanger sequencing, and all were resistant to glycopeptides (VanA phenotype).

CONCLUSIONS

This article describes the first UK outbreak with a single strain of linezolid- and glycopeptide-resistant E. faecium harbouring the cfr gene, affecting five patients in a nephrology unit. Following the implementation of aggressive infection control measures, no further cases were detected beyond a two-week period.

[Senegalese experience with acute viral conjunctivitis]

PURPOSE

To study the epidemiological and clinical aspects of acute enteroviral and adenoviral conjunctivitis.

PATIENTS AND METHODS

A prospective study was conducted between January 1st and October 31st, 2015, jointly between two Ophthalmology services and a virology laboratory, which identified 51 patients. Were included all patients who presented a painful red eye without loss of visual acuity associated with secretions,evolving for less than 4weeks RESULTS: The mean age was 32 years, and the sex ratio 1:1. Over half of our patients (61%) came from populous districts. A history of the virus "going around" was reported by 30 patients (59% of cases). Virological testing was positive in 35 patients (68.7% of cases). Over 90% of samples collected during the first week of clinical signs were positive.

CONCLUSION

Viral conjunctivitis is a contagious condition, the spread of which is favored by promiscuity. Adenovirus and enterovirus are the main causative agents. They are present on an endemic scale in Senegal; thus, the need for better epidemiological surveillance in order to limit spread.

[Isolated microspherophakia in a Senegalese family]

PURPOSE

To report the clinical investigation of isolated microspherophakia involving a Senegalese family in order to appreciate its functional impact.

OBSERVATIONS

This is a rural family comprised of 7 members. The sibship included three girls and two boys. One of the girls, who lived in a distant zone, was unable to be examined. Of all the examined members of the family, only the father was unaffected by the illness. There was no consanguinity. The general medical examination was normal. The best-corrected visual acuity (VA) for the girls was 2/10. For one of the boys, BCVA was 8/10 for both eyes, and for the other, BCVA was 10/10 for the right eye and 8/10 for the left eye. The mother's VA was 10/10 and P2 without correction. Myopia and astigmatism were present in the 4 children of the sibship. During the examination, we noted the presence of small crystalline lenses, which were very round and presented an abnormal visibility of the lens equator and zonular fibers. The diagnosis of microspherophakia was confirmed by measurement of the lens diameters by ultrasound biomicroscopy. Complications were present in the girls, including pupillary block glaucoma and amblyopia for the elder, and retinal degeneration and amblyopia for the younger daughter. The elder daughter was managed medically with glaucoma drops. The younger daughter received optical correction and a prophylactic Argon LASER treatment. The two boys received optical correction. No treatment was recommended for the mother.

CONCLUSION

Microspherophakia is a rare condition. Some serious complications can lead to amblyopia. A better multidisciplinary evaluation would allow for early detection and a better prognosis.

Successive outbreaks of Group A streptococcus (GAS) in care of the elderly settings; lessons learned

Group A streptococcal (GAS) outbreaks in care of the elderly settings are rare. We describe two successive outbreaks involving care of the elderly patients. The first outbreak involved 18 patients and the second involved six patients and two healthcare workers. We describe the difficulties encountered controlling GAS outbreaks in care of the elderly settings and how the lessons learned from the first outbreak influenced management of the second incident. Stringent infection control measures including isolation until completion of treatment and re-screening for evidence of eradication were required to bring outbreak one under control. These measures were adopted early in outbreak two and we suspect that these measures and the rapid identification of carriers brought this second outbreak under control quickly.

Bacterial diversity in an industrial wastewater bioreactor

Industrial wastewater bioreactors are potentially important sources of novel biocatalysts. However, the microbial populations in these bioreactors are not well characterized. The microbial community in an industrial wastewater bioreactor was surveyed by extracting DNA from a sample of activated sludge, followed by PCR amplification and sequencing of cloned 16S rRNA genes. A total of 407 cloned 16S rRNA gene sequences were compared with 88 bacterial isolates cultured from the same sample of sludge using a variety of standard media. Most of the bacteria detected by the PCR-based approach were beta-subdivision Proteobacteria, whereas most of the cultured bacteria were gamma-subdivision Proteobacteria. Only a few types of bacteria were detected by both approaches. These observations indicate that multiple techniques are necessary to characterize the microbial diversity in any complex ecosystem.

Secular declines in Spearman's g: some evidence from the United States

The Flynn Effect (J. Flynn, 1987) refers to the apparent increases in intelligence quotient (IQ) observed over the past few decades. A related phenomenon is that the variance in test scores accounted for by Spearman's g (C. Spearman, 1904) varies according to IQ level. That is, g accounts for less variance in high IQ groups than in low IQ groups. Spearman termed this variant aspect of g the "law of diminishing returns." This study extends prior research on the Flynn Effect and the law of diminishing returns by examining changes in the statistical importance of Spearman's g that may accompany secular increases in IQ. Based on the standardization data from the United States versions of the Wechsler scales (i.e., Wechsler Preschool and Primary Scales of Intelligence, D. Wechsler, 1967; Wechsler Intelligence Scale for Children, D. Wechsler, 1949; Wechsler Adult Intelligence Scale, D. Wechsler, 1955), this study indicated that, in most cases, the statistical significance of Spearman's g has indeed declined over the past several years. A. R. Jensen (1998) suggested that the components of the Flynn Effect warrant special investigation. The present study addresses this issue, in part by analyzing the Verbal and Performance subscales of the Wechsler scales. Additionally, this study further confirms the law of diminishing returns as applicable to different ages and time periods.

Comparison of Neoral and Sandimmun cyclosporin A pharmacokinetic profiles in young renal transplant recipients

A major factor influencing whole blood cyclosporin A levels in young children with renal transplants is the variable absorption of Sandimmun (SIM). Neoral (NEO) is a new microemulsion of cyclosporin A (CYA) that has been reported to have better absorption characteristics. We compared the pharmacokinetics of SIM and NEO in nine renal transplant recipients aged less than 11 years (range 4.8-10.9 years) and observed clinical parameters during 6 months of NEO therapy. Median CYA dosage was 149 mg/m2 per day (range 98-226). We observed an increase in the maximum CYA concentration (Cmax) of 114%, an increase in area under the curve (AUC) of 71% and the time to reach Cmax was reduced from 1.75 h to 1.25 h with NEO, while 12-h trough levels (C12 h) did not change significantly. AUC correlated with C12 h for SIM (r2 = 0.833) and NEO (r2 = 0.699) and also C1.5 h for NEO (r2 = 0.775). During 24 weeks' follow-up, the coefficient of variation of CYA levels was lower for NEO (13%) than for SIM (20%). Although CYA dosages at the start and the end of 6 months on NEO were similar, only one patient was maintained on a constant dose. Four patients had acute reversible rises in plasma creatinine which responded to a 11% reduction in NEO dose; their increase in AUC was greater than those patients not showing a rise in plasma creatinine. Overall, median plasma creatinine was unchanged at the end of the study. NEO was well tolerated by the patients; temporary nausea and headache were experienced by three patients and one of them stopped NEO after 20 days. Other biochemical parameters were not significantly different on NEO.

Response of filtered eyes to digital ocular pressure

PURPOSE

To examine the effect of digital ocular pressure (DOP) on the intraocular pressure (IOP) of eyes 3 months or longer after successful glaucoma filtering surgery.

METHODS

Fifteen patients participated in this study. Each had one eye with a successful filtering operation (IOP < or = 21 mmHg without medications) and a fellow eye that was not operated on, which served as a control. The authors measured IOP in both eyes before and serially after DOP until return to baseline or for 3 hours to determine the amounts and durations of reductions. The authors monitored changes of bleb morphology and searched for complications.

RESULTS

Digital ocular pressure 3 months or more after successful filtering surgery reduced IOP by approximately 50% of baseline. The time after DOP for 50% of eyes to have intraocular pressure return to within 2 mmHg of baseline was 95 minutes; 40% recovered within 20 minutes and 30% had not recovered by 3 hours. Eyes with localized blebs recovered faster than did eyes with diffuse blebs. Transient shallowing of the anterior chamber developed in one eye. Otherwise, there were no adverse effects. Time since surgery and baseline IOP were not correlated with response. Fellow eyes had minimal response to DOP and recovered within 30 minutes.

CONCLUSION

This study shows that a substantial, transient decrease of IOP after DOP occurs in glaucomatous eyes with a well-functioning bleb 3 months to 6 years after filtering surgery. The duration exceeds 90 minutes in more than 50% of the eyes tested and 180 minutes in more than 30% of the eyes tested.

A controlled study of the psycho-social development of children conceived following insemination with donor semen

Although donor insemination has been used to produce pregnancies for many years, there has been little information on how children conceived in this unusual manner develop psycho-socially. We have therefore carried out a controlled quantitative assessment comparing children who were conceived by donor insemination to adoptees and naturally conceived children who were matched for age and sex. We conclude that the psycho-social development of donor insemination children was no different from the two control groups.

Lateral flagellum of Vibrio fluvialis: a species-specific antigen

Antiserum against lateral flagella (L flagella) of Vibrio fluvialis AQ 0007 was prepared, and H agglutination tests of V. fluvialis strains were carried out with the antiserum. Thirty-seven strains isolated from human patients, marine products, or seawater were tested. All strains, except three which had lost the ability to form L flagella, agglutinated with that antiserum. The antiserum did not agglutinate other vibrio species having L flagella, whereas antisera against L flagella of other vibrios did not agglutinate V. fluvialis. These results suggest that the L flagellar antigen of V. fluvialis is common and specific to the species, and is a useful tool for serological identification of the organism.

Serological method for identification of Vibrio parahaemolyticus from marine samples

Use of agglutination with antiserum against lateral flagella (H-agglutination) for the identification of Vibrio parahaemolyticus was studied. Sucrose-negative bacteria were isolated from seawater, and their characterization was carried out by traditional biological tests and slide agglutination with antiserum specific to lateral flagella of V. parahaemolyticus. Of 135 strains isolated, 78 were identified as V. parahaemolyticus by biological tests and were agglutinated with the above serum. Fifty-five strains did not agglutinate with the serum, and their biological characteristics were different from those of V. parahaemolyticus. Two strains also differed from V. parahaemolyticus in some biological characteristics but agglutinated with the antiserum. All clinically isolated V. parahaemolyticus strains also agglutinated with the above serum. These results suggest that our serological method is useful for the identification of V. parahaemolyticus, especially for samples in which there are many organisms related to V. parahaemolyticus, because many biological tests can be omitted.